Ectopic pregnancy rates and racial disparities in the Medicaid population 2004–2008

Capsule:
Ectopic pregnancy rates among Medicaid beneficiaries declined slightly in California, Illinois, and New York in 2000–2008, but African American women face consistently higher rates than whites across 14 diverse states.

Authors:
Debra B. Stulberg, M.D., M.A., Loretta R. Cain, Ph.D., Irma Dahlquist, B.S., Diane S. Lauderdale, Ph.D.

Volume 102, Issue 6, Pages 1671-1676

Abstract:

Objective:
To assess 2004–2008 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000–2008 time trends in three states and to identify differences in rate by race/ethnicity.

Design:
Secondary analysis of Medicaid administrative claims data.

Setting:
Not applicable.

Patient(s):
Women ages 15–44 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 2004–2008 (n = 19,135,106) and in California, Illinois, and New York in 2000–2003.

Intervention(s):
None.

Main Outcome Measure(s):
Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births).

Result(s):
The 2004–2008 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer term data were available (California, Illinois, and New York), the rate declined significantly in 2000–2008. In all 14 states, black women were more likely to experience an ectopic pregnancy compared with whites (relative risk, 1.46; 95% confidence interval, 1.45–1.47).

Conclusion(s):
Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites.

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